Table_7_Survival After Treatable Hepatocellular Carcinoma Recurrence in Liver Recipients: A Nationwide Cohort Analysis.docx

BackgroundSurvival after post-transplant recurrence of HCC is dismal, and almost all treatments for recurrent HCC are off-labeled, without an extensive large-scale analysis. We aimed to delineate their post-recurrence courses and define benchmarks for comparing future treatment effectiveness.MethodsThree national databases, including health insurance, catastrophic illness, and the cause of death, were linked for cohort establishment and data collection during the period from 2005 to 2016. Patients with HCC recurrence ≥6 months after transplant surgery and under treatment were recruited for survival analysis. Selection of treatment strategies for HCC recurrence after liver transplant was based on the same criteria for those without liver transplant.ResultsOf 2,123 liver transplant recipients, 349 developed HCC recurrence ≥6 months after liver transplant, and the median recurrence time was 17.8 months post-transplant. Within 2 years of treatment, 61% patients showed recurrence (early recurrence group), and survival in these patients was poorer than in the late recurrence group. According to a multivariable analysis, the transplant era before 2008 and radiofrequency ablation were associated with good prognosis, whereas receiving sorafenib and radiotherapy was associated with poor prognosis. The effect of transplant era became insignificant after stratification by recently receiving pretransplant transarterial chemoembolization.ConclusionTiming of recurrence and interventions used were associated with the outcomes of patients with post-transplant HCC recurrence. These data provide the benchmark and indicate the critical period and high-risk factors for further therapeutic trial consideration.

背景：肝细胞癌（HCC）移植术后复发患者的生存状况极为堪忧，几乎所有针对复发HCC的治疗均为超说明书用药，缺乏广泛的大规模分析。本研究旨在描绘其复发后的病程，并定义未来治疗有效性的比较基准。方法：从2005年至2016年期间，将包括医疗保险、重大疾病和死因在内的三个国家级数据库进行链接，以建立队列并收集数据。招募了术后6个月以上复发且正在接受治疗的HCC患者进行生存分析。肝移植术后HCC复发的治疗方案选择基于未进行肝移植患者的相同标准。结果：在2123名肝移植受者中，349名患者在肝移植术后6个月以上发生HCC复发，中位复发时间为术后17.8个月。在治疗2年内，61%的患者出现复发（早期复发组），这些患者的生存状况劣于晚期复发组。多变量分析显示，2008年之前的移植时代和射频消融与良好的预后相关，而索拉非尼和放疗与不良预后相关。在按近期接受术前经动脉化疗栓塞术进行分层后，移植时代的影响变得不显著。结论：复发时间和采取的干预措施与移植术后HCC复发患者的预后相关。这些数据提供了基准，并指出了进一步治疗试验考虑的关键时期和高危因素。